Emergency Medicine Block Tutor Guide

Problem 5

# A 27 year old woman called Nora has presented while you are intake

# She has a past history of self harm, hospitalizations for overdose and past use of
benzodiazepines & “ice”

# She is homeless and does not have an open file at your service

# Nora presents saying she wants some valium or she will kill herself. She is tearful,
agitated and distracted but oriented to place and time

# She states she is very anxious, feels paranoid about people watching her on TV and
complains of tinnitus

Questions:
1. What preliminary Axis I diagnosis would give of your patient and why? Use the PPDGJ-
3 to look up the Axis I disorders and select one or two that best fit the clinical picture.

2. What, if any, medical danger(s), do you see or should you consider for the patient? Give
reasons for your answer.

3. What transference and counter-transference issues would you expect to be present in

working with the patient?

4. Finally, based on all the above information, what is your action and why?

Discuss this problem!